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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 NON-KEFUNDABLE Invoice # Permit ID# GHLL LU`J Y06 -/ow t -UK lnsrtLnurvs unKta I r CHK rKUM vnl It 11 auUC Joe ADDRESS PERMIT I 14 INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMB/ER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: _� SEPTIC TANK TYPE/MFG 61C X I.- CAPACITY gal # OF COMPARTMENTS_ C) 6 3 d 3 U 9 � I I CROSS STREET ! 1 / �-f �G 17 )`Oel /'-el 1�I A{fPIN PARCEL SIZE LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES SS ft dre> � DISTANCE TO NEAREST WELL ft FOUNDATION /S It PROPERTY LINE ft Ce C)f i1 FILTER BED WIDTH ft LENGTH ft DEPTH it OWNER NAME DISTANCE TO NEAREST WELL fl FOUNDAI-ION ft PROPERTY LINE ft ❑ c 1 r4 f-(-' (P Z O P/HONE DISTANCE TO NEAREST WELL fl FOUNDATION fl PROPERTY LINE ft l N) I j �J�G/ /y a y o OWNER ADDRESS a i (7'p/(/ 1 '` Cj CITY/STATE/ZIP Or(/' I SEEPAGE PITS NUMBER WIDTH 4/ -30 R DEPTH IPS' ft !Ma t u DISTANCE TO NEA EST WELL /SQ It FOUNDATION T,Jv� Z ft PROPERTY LINE S � It -L PHONE r%,s — t7 �O / CONTRACTOR 1� /lam V// __o o24 / L��7- /,; �f CONTRACTOR ADDRESS ( 1.1 ellj CIN /STATE/ZIP ' la)9 LICENSE Dx-02 C' C-36 OTHER NUMBER 1/5W4EXPIRATION DATE WATER TABLE DEPTH: �/ IJ v It GEOGRAPHICAL INFORMATION: Coordinates X Y Invoice # Permit ID# PERC TEST # BUILDING PERMIT # 103 �? SCJ LAND USE APPLICATION # TYPE OF WORK: ^ NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMB/ER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: _� SEPTIC TANK TYPE/MFG 61C X I.- CAPACITY gal # OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE To NEAREST: WELL /-70/R FOUNDATION It PROPERTY LINE & S It LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ��❑[[] p LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES SS ft � DISTANCE TO NEAREST WELL ft FOUNDATION /S It PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH it DISTANCE TO NEAREST WELL fl FOUNDAI-ION ft PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH fl DISTANCE TO NEAREST WELL fl FOUNDATION fl PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH it LENGTH ft DEPTH it DISTANCE TO NEAREST WELL fl FOUNDATIONft PROPERTY LINE It SEEPAGE PITS NUMBER WIDTH 4/ -30 R DEPTH IPS' ft DISTANCE TO NEA EST WELL /SQ It FOUNDATION T,Jv� Z ft PROPERTY LINE S � It HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 DEPARTMENT US ONLY //// [ /- Application Accepted By /G L Date Area Employee ID# I V Final Inspection By Date 1 r� �`> /� SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft' Pit/Sump Soil Character: COjviMElyTS SFW7tCl-A !10C— /fir- PE SC Received heck#/ Amount ate Permit/ Code INFO 8 Remitted Service Re est # Invoice # Permit ID# ail ikmi Vi4bq Sy') 3 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18